Ovarian Torsion and Adnexal Pathophysiology

Ovarian torsion is a gynaecological emergency in which the ovary, often together with the fallopian tube, twists around its vascular pedicle. The resulting venous congestion, arterial compromise and tissue ischaemia provoke an acute onset of lower abdominal pain, nausea and, in some cases, peritoneal irritation. Predisposing factors include ovarian masses or cysts, paraovarian lesions and anatomical variants that increase mobility of the adnexa. In paediatric and adolescent populations, functional cysts and benign tumours may precipitate torsion, whereas in adults paraovarian cysts and endometriotic cysts are more common culprits. If not promptly recognised and treated by surgical detorsion or resection, prolonged ischaemia–reperfusion injury can lead to oxidative stress, inflammatory cascade activation and permanent loss of ovarian function. Diagnostic evaluation centres on transvaginal or transabdominal ultrasonography with Doppler assessment of ovarian blood flow; cross-sectional imaging such as magnetic resonance imaging may be employed to clarify equivocal findings. Current management principles prioritise ovarian preservation whenever feasible, balancing the risks of necrosis against those of detorsion and potential reperfusion injury. Emerging therapeutic strategies aim to mitigate oxidative damage and optimise tissue recovery following detorsion.

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Ovarian Torsion and Adnexal Pathophysiology publication trend

The graph below shows the total number of articles in ovarian torsion and adnexal pathophysiology across all publications each year (not limited to Nature Index journals).

Technical terms

Ovarian torsion: Twisting of the ovary and often the fallopian tube around its vascular supply, leading to compromised perfusion and acute abdominal pain.

Adnexa: The appendages of the uterus, comprising the ovaries, fallopian tubes and their supporting ligaments.

Ischaemia–reperfusion injury: Tissue damage caused when blood supply returns after a period of oxygen deprivation, characterised by oxidative stress and inflammation.

Doppler ultrasonography: An imaging technique that assesses blood flow velocity and direction within vessels by detecting frequency shifts of reflected ultrasound waves.

Biomarkers: Measurable biological molecules that can indicate normal or pathological processes or responses to therapeutic interventions.

References

1. Are There Non-Invasive Biomarker(s) That Would Facilitate the Detection of Ovarian Torsion? A Systematic Review and Meta-Analysis. International Journal of Molecular Sciences (2024).
2. European Society of Paediatric Radiology abdominal imaging task force recommendations in paediatric uroradiology, part IX: Imaging in anorectal and cloacal malformation, imaging in childhood ovarian torsion, and efforts in standardising paediatric uroradiology terminology. Pediatric Radiology (2017).
3. Atorvastatin-mediated downregulation of VCAM-1 and XO/UA/caspase 3 signaling averts oxidative damage and apoptosis induced by ovarian ischaemia/reperfusion injury. Redox Report (2022).